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Alecrim MDJ, Mattar R, Torloni MR. Pregnant women's experience of undergoing an oral glucose tolerance test: A cross-sectional study. Diabetes Res Clin Pract 2022; 189:109941. [PMID: 35690268 DOI: 10.1016/j.diabres.2022.109941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022]
Abstract
AIMS The oral glucose tolerance test (OGTT) is routinely performed in most pregnancies; however, there are few studies which document the experience of taking this test. We assessed the experience of pregnant women during an OGTT. METHODS This cross-sectional study included 152 women (24-32 weeks' gestation) and assessed their knowledge, anxiety (Spielberg anxiety inventory test-STAI), and physical pain (0-10 visual analog scale) during the OGTT. The Friedman test was used to compare pain scores over time. RESULTS 61 (40%) participants did not know why they were doing the OGTT and 73 (48%) women had high state-anxiety levels (STAI ≥ 41 points, 20-80 scale). Participants had mild to moderate pain scores immediately after the first and second blood draws (3.9 ± 2.7 and 3.8 ± 2.3, respectively) that decreased significantly after the third blood draw (2.8 ± 2.4, P < 0.001). Nearly half (n = 71, 47%) of the participants were very or extremely bothered with having to drink the glucose solution. CONCLUSIONS The OGTT was associated with high levels of anxiety and mild to moderate physical pain. Ingestion of the glucose solution was perceived as the most difficult part of the test. Good strategies can help to mitigate some of these negative experiences while undergoing an OGTT.
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Affiliation(s)
- Maria de J Alecrim
- Department of Obstetrics, São Paulo Federal University, Rua Napoleão de Barros, 875, São Paulo, SP 04024-002, Brazil.
| | - Rosiane Mattar
- Department of Obstetrics, São Paulo Federal University, Rua Napoleão de Barros, 875, São Paulo, SP 04024-002, Brazil.
| | - Maria R Torloni
- Department of Obstetrics, São Paulo Federal University, Rua Napoleão de Barros, 875, São Paulo, SP 04024-002, Brazil; Evidence Based Health Care Post-Graduate Program, Department of Medicine, São Paulo Federal University, Rua Botucatu 740, 3° andar, São Paulo, SP 04023-900, Brazil.
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Liu J, Wang S, Leng J, Li J, Huo X, Han L, Liu J, Zhang C, Chan JCN, Yu Z, Hu G, Yang X. Impacts of gestational diabetes on quality of life in Chinese pregnant women in urban Tianjin, China. Prim Care Diabetes 2020; 14:425-430. [PMID: 31918978 DOI: 10.1016/j.pcd.2019.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 12/16/2022]
Abstract
AIMS This study aimed to examine impacts of gestational diabetes mellitus (GDM) on quality of life (QoL) domains in Chinese pregnant women. METHODS We recruited 13,358 pregnant women in Tianjin, China. GDM was diagnosed using the criteria of International Association of Diabetes and Pregnancy Study Group. QoL was measured using the 36-Item Short-Form Health Survey. General linear model was used to obtain β-coefficient and 95% confidence intervals (CI) of GDM for QoL domain and summary scores. RESULTS 7.25% of the pregnant women developed GDM. Among the QoL domain and summary scores, only general health (GH) score was lower in the GDM group than in the non-GDM group. GDM and advanced maternal age (i.e., ≥ versus <30 years) were negatively associated with GH in multivariable analyses (β-coefficient: -1.17, 95%CI: -2.17 to -0.17 & -0.79, -1.40 to -0.18, respectively). In subgroup analyses, the β-coefficient of GDM for GH among women with maternal age ≥30 years was enhanced to -2.17 (-3.94 to -0.40) in multivariable analysis while the β-coefficient of GDM for GH among women aged <30 years was attenuated to non-significance. CONCLUSIONS GDM and advanced maternal age were associated with reducing GH, and presence of advanced maternal age markedly increased the effect of GDM on GH.
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Affiliation(s)
- Jinnan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Shuting Wang
- Project Office, Tianjin Women and Children's Health Center, Tianjin, China
| | - Junhong Leng
- Project Office, Tianjin Women and Children's Health Center, Tianjin, China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiaoxu Huo
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Liang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jin Liu
- Project Office, Tianjin Women and Children's Health Center, Tianjin, China
| | - Cuiping Zhang
- Project Office, Tianjin Women and Children's Health Center, Tianjin, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and The Chinese University of Hong Kong-Prince of Wales Hospital-International Diabetes Federation Centre of Education, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhijie Yu
- Population Cancer Research Program and Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Gang Hu
- Chronic Disease Epidemiology Laboratory, Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Xilin Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China; Tianjin Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, China.
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3
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Lee KW, Ching SM, Devaraj NK, Chong SC, Lim SY, Loh HC, Abdul Hamid H. Diabetes in Pregnancy and Risk of Antepartum Depression: A Systematic Review and Meta-Analysis of Cohort Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113767. [PMID: 32466479 PMCID: PMC7311953 DOI: 10.3390/ijerph17113767] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/18/2020] [Accepted: 05/22/2020] [Indexed: 12/18/2022]
Abstract
Previous literature has reported that patients with diabetes in pregnancy (DIP) are at risk of developing antepartum depression but the results have been inconsistent in cohort studies. We conducted a systematic review and performed a meta-analysis to quantify the association between DIP and risk of antepartum depression in cohort studies. Medline, Cinahl, and PubMed databases were searched for studies investigating DIP involving pregnant women with pre-existing diabetes and gestational diabetes mellitus and their risk of antepartum depression that were published in journals from inception to 27 December 2019. We derived the summary estimates using a random-effects model and reported the findings as pooled relative risks (RR) and confidence interval (CI). Publication bias was assessed using a funnel plot and was quantified by Egger and Begg’s tests. Ten studies, involving 71,036 pregnant women were included in this meta-analysis. The pooled RR to develop antepartum depression was (RR = 1.430, 95% CI: 1.251–1.636) among women with gestational diabetes mellitus. Combining pregnant women with pre-existing diabetes mellitus and gestational diabetes mellitus, they had a significant increased risk of developing antepartum depression (RR = 1.431, 95% CI: 1.205–1.699) compared with those without it. In comparison, we found no association between pre-existing diabetes mellitus in pregnancy (RR = 1.300, 95% CI: 0.736–2.297) and the risk of developing antepartum depression. This study has a few limitations: first, different questionnaire and cut-off points were used in evaluation of depression across the studies. Second, there was a lack of data on history of depression prior to pregnancy, which lead to confounding bias that could not be solved by this meta-analysis. Third, data were dominated by studies in Western countries; this is due to the studies from Eastern countries failing to meet our inclusion criteria for statistical analysis. Women with gestational diabetes mellitus have an increased risk of developing antepartum depression compared to those without the disease. Therefore, more attention on the mental health status should be given on pregnant women diagnosed with pre-existing diabetes mellitus and gestational diabetes mellitus.
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Affiliation(s)
- Kai Wei Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia; (K.W.L.); (N.K.D.)
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia; (K.W.L.); (N.K.D.)
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia
- Correspondence:
| | - Navin Kumar Devaraj
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia; (K.W.L.); (N.K.D.)
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia
| | - Seng Choi Chong
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia;
| | - Sook Yee Lim
- Department of Nutrition and Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia;
| | - Hong Chuan Loh
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Perai 13700, Pulau Pinang, Malaysia;
| | - Habibah Abdul Hamid
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor 43400, Malaysia;
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Association Analysis of 14 Candidate Gene Polymorphism with Depression and Stress among Gestational Diabetes Mellitus. Genes (Basel) 2019; 10:genes10120988. [PMID: 31801286 PMCID: PMC6947641 DOI: 10.3390/genes10120988] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 12/14/2022] Open
Abstract
The association of candidate genes and psychological symptoms of depression, anxiety, and stress among women with gestational diabetes mellitus (GDM) in Malaysia was determined in this study, followed by the determination of their odds of getting psychological symptoms, adjusted for socio-demographical background, maternal, and clinical characteristics. Single nucleotide polymorphisms (SNPs) recorded a significant association between SNP of EPHX2 (rs17466684) and depression symptoms (AOR = 7.854, 95% CI = 1.330–46.360) and stress symptoms (AOR = 7.664, 95% CI = 1.579–37.197). Associations were also observed between stress symptoms and SNP of OXTR (rs53576) and (AOR = 2.981, 95% CI = 1.058–8.402) and SNP of NRG1 (rs2919375) (AOR = 9.894, 95% CI = 1.159–84.427). The SNP of EPHX2 (rs17466684) gene polymorphism is associated with depression symptoms among Malaysian women with GDM. SNP of EPHX2 (rs17466684), OXTR (rs53576) and NRG1 (rs2919375) are also associated with stress symptoms.
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Mokhlesi S, Simbar M, Ramezani Tehrani F, Kariman N, Alavi Majd H. Quality of life questionnaire for women with gestational diabetes mellitus (GDMQ-36): development and psychometric properties. BMC Pregnancy Childbirth 2019; 19:454. [PMID: 31783733 PMCID: PMC6884843 DOI: 10.1186/s12884-019-2614-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/19/2019] [Indexed: 11/20/2022] Open
Abstract
Background Gestational diabetes mellitus carries serious risks to mother and fetus and causes social, mental, and psychological consequences which can affect mothers’ quality of life. Accordingly, this study aims to develop and assess the psychometric properties of quality of life questionnaire for women with gestational diabetes mellitus. Methods A methodological study of sequential exploratory mixed method was developed and implemented. It included qualitative (development of a quality of life questionnaire for mothers with GDM) and quantitative (assessment of psychometric prosperities of quality of life questionnaire for mothers with GDM) phases. Results Based on the findings of the qualitative phase and literature review, the primary questionnaire was prepared with 142 items. The outcome of face validity and content validity assessment was a 67-item questionnaire. S-CVI and S-CVR turned out to be 0.92 and 0.68, respectively. The results of exploratory factor analysis yielded an instrument with 36 items in five domains including concerns about high-risk pregnancy, perceived constraints, disease complications, medication and treatment, and support. Five factors explained 46.68% of the total variance of the questionnaire. The results indicated a moderate and significant correlation between the questionnaire of “Diabetes Clients Quality Of Life” and the researcher-made questionnaire (r = 0.63). Cronbach’s alpha coefficient for the entire scale was 0.93 and the intra-class correlation coefficient was 0.95. Conclusion Quality of life questionnaire for mothers with GDM is a valid and reliable tool capable of measuring the quality of life of women with GDM.
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Affiliation(s)
- S Mokhlesi
- Department of medical science,Qom branch, Islamic azad University, Qom, Iran
| | - M Simbar
- Professor, Midwifery and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - F Ramezani Tehrani
- Professor, Gynecology Department, Reproductive Endocrinology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - N Kariman
- Midwifery and Reproductive Health Department, school of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Alavi Majd
- Professor, Department of Biostatistics,Faculty of Paramedical Sciences, Shahid Beheshti Medical University, Tehran, Iran
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Lee KW, Ching SM, Hoo FK, Ramachandran V, Chong SC, Tusimin M, Mohd Nordin N. Prevalence and factors associated with depressive, anxiety and stress symptoms among women with gestational diabetes mellitus in tertiary care centres in Malaysia: a cross-sectional study. BMC Pregnancy Childbirth 2019; 19:367. [PMID: 31638930 PMCID: PMC6805560 DOI: 10.1186/s12884-019-2519-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 09/20/2019] [Indexed: 12/16/2022] Open
Abstract
Background Research on antenatal depressive, anxiety and stress symptoms among women with gestational diabetes mellitus (GDM) is lacking in Malaysia. This study aimed to determine the prevalence and factors associated with antenatal depressive, anxiety and stress symptoms among Malaysian women with GDM. Methods This was a descriptive, cross-sectional study of 526 women with GDM. Depressive, anxiety and stress symptoms are defined as the final score in mild to extremely severe risk in the severity rating scale. Data analysis was performed using SPSS v.21, while multiple logistic regression was used to identify predictors of depressive, anxiety and stress symptoms. Results Prevalence of anxiety symptoms was highest (39.9%), followed by depressive symptoms (12.5%) and stress symptoms (10.6%) among women with GDM. According to multiple logistic regression analyses, younger age (OR = 0.955, 95% CI = 0.919–0.993), comorbidity with asthma (OR = 2.436, 95% CI = 1.219–4.870) and a family history of depression and anxiety (OR = 4.782, 95% CI = 1.281–17.853) had significant associations with antenatal anxiety symptoms. Being non-Muslim (OR = 2.937, 95% CI = 1.434–6.018) and having a family history of depression and anxiety (OR = 4.706, 95% CI = 1.362–16.254) had significant associations with antenatal depressive symptoms. Furthermore, being non-Muslim (OR = 2.451, 95% CI = 1.273–4.718) had a significant association with antenatal stress symptoms. Conclusions Within a population of women with GDM in Malaysia, those at higher risk of having depressive, anxiety and stress symptoms can be identified from several baseline clinical characteristics. Clinicians should be more alert so that the high-risk patients can be referred earlier for further intervention.
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Affiliation(s)
- Kai Wei Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia. .,Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia. .,Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, Bandar Sunway, Malaysia.
| | - Fan Kee Hoo
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Vasudevan Ramachandran
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Seng Choi Chong
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Maiza Tusimin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
| | - Noraihan Mohd Nordin
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia
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Jirojwong S, Brownhill S, Dahlen HG, Johnson M, Schmied V. Going up, going down: the experience, control and management of gestational diabetes mellitus among Southeast Asian migrant women living in urban Australia. Health Promot J Austr 2019; 28:123-131. [PMID: 27745571 DOI: 10.1071/he15130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 08/04/2016] [Indexed: 01/15/2023] Open
Abstract
Issue addressed In many developed countries the rate of gestational diabetes mellitus (GDM) for Asian-born women is higher than other groups. Studies suggest that some women have limited knowledge of the disease and poor self-management leading to health problems for themselves and their baby. Few studies report the experience of GDM among Southeast Asian migrant women living in Australia and factors that influence their management of the disease. Methods A qualitative interpretive design was used to explore Southeast Asian migrant women's experience and management of GDM. Women diagnosed with the disease during pregnancy were recruited from an antenatal clinic at two Sydney metropolitan hospitals. Nineteen women were interviewed in their first language. Thematic analysis was used to analyse the data. Results A diagnosis of GDM conferred an unanticipated 'up and down' experience for this group of Southeast Asian women. Their experience of the disease, likened to an elevator ride, was modulated by 'insulin' and 'information' used to control the disease and manage blood glucose levels, dietary levels, exercise levels and anxiety levels. Conclusions Health promotion material that captures the fluctuating experience of GDM has the potential to help women, particularly at the time of diagnosis, to be better prepared, and health professionals to be better informed to control and manage the disease more effectively. So what? GDM is a serious problem. The model generated from our study has the potential to better inform health professionals to prepare women for the inevitable fluctuating physical and emotional effects of the disease. Culturally sensitive material and an educational strategy based on the model may also facilitate women's lifestyle changes and compliance, and improve migrant women's relationship with, and trust in, health professionals involved in their GDM care.
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Affiliation(s)
- Sansnee Jirojwong
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Suzanne Brownhill
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, PO Box 968, North Sydney, NSW 2059, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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Martínez-Cruz N, Rapisarda AMC, Soriano-Ortega KP, Arce-Sánchez L, Cianci A, Ortega-Gonzalez C, Torres-Herrera U, Espino-Y-Sosa S, Estrada-Gutierrez G, Montoya-Estrada A, Romo-Yañez J, Reyes-Muñoz E. Perinatal Outcomes in Mexican Women with Untreated Mild Gestational Diabetes Mellitus Diagnosed by the International Association of Diabetes and Pregnancy Study Groups Criteria. Diabetes Metab Syndr Obes 2019; 12:2667-2674. [PMID: 31908507 PMCID: PMC6924587 DOI: 10.2147/dmso.s229671] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/13/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To compare the risk of adverse perinatal outcomes (APO) between pregnant women with mild gestational diabetes mellitus (GDM) diagnosed by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, on no specific treatment, versus pregnant women without GDM. PATIENTS AND METHODS A retrospective cohort study of pregnant women referred to the Instituto Nacional de Perinatología, in Mexico City, for prenatal care and delivery. Eligibility criteria were singleton pregnancy, age >18 years, gestational age 20-28 weeks, and no history of pre-gestational diabetes. The study population was divided into two groups: Group 1, comprising women with mild GDM defined by one abnormal glucose value at the oral glucose tolerance test (OGTT) according to IADPSG criteria [fasting: 5.1-5.2 mmol/L (92-94 mg/dL) or 2h 8.5-8.56 mmol/L (153-154 mg/dL)], who did not receive specific treatment for GDM, and Group 2, comprising women without GDM, matched for maternal age and pre-gestational body mass index (BMI). Women with two or more abnormal OGTT values, pre-gestational diabetes, any chronic disease, or multiple pregnancies were excluded. RESULTS As many as 282 women were included in each group. There were no significant differences in basal characteristics between groups. APO analysis showed that newborn weight was significantly higher in Group 1 (3042.4±499g) vs Group 2 (2910±565g) p=0.003; conversely, the incidence of large for gestational age (LGA) and macrosomic neonates was similar in both groups (6 vs 5.7% and 2.1 vs 2.2%, respectively). There were no differences in rates of preeclampsia and gestational hypertension, cesarean and preterm delivery, or premature rupture of membranes. A sub-analysis by maternal pre-gestational BMI showed that LGA incidence was significantly higher among babies born to women with pre-gestational BMI ≥30 kg/m2 in both groups. CONCLUSION The risk of APO was similar among Mexican women with mild untreated GDM diagnosed by IADPSG criteria, compared to pregnant women without GDM. Pre-gestational BMI was an independent risk factor for LGA.
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Affiliation(s)
- Nayeli Martínez-Cruz
- Department of Endocrinology, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México
| | | | - Karla Patricia Soriano-Ortega
- Division of Clinical Research, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México
| | - Lidia Arce-Sánchez
- Department of Endocrinology, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México
| | - Antonio Cianci
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Carlos Ortega-Gonzalez
- Department of Endocrinology, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México
| | - Ursula Torres-Herrera
- Department of Endocrinology, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México
| | - Salvador Espino-Y-Sosa
- Division of Clinical Research, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México
| | - Guadalupe Estrada-Gutierrez
- Direction of Research, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México
| | - Araceli Montoya-Estrada
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México
| | - José Romo-Yañez
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México
| | - Enrique Reyes-Muñoz
- Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología “Isidro Espinosa de los Reyes”, Mexico City, México
- Correspondence: Enrique Reyes-Muñoz Department of Gynecological and Perinatal Endocrinology, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800 Lomas Virreyes, Miguel, Hidalgo11000, Mexico CityMexicoTel +52 5555209900 Ext 307 Email
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Abstract
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. However, debate continues to surround the diagnosis and treatment of GDM despite several recent large-scale studies addressing these issues. The purposes of this document are the following: 1) provide a brief overview of the understanding of GDM, 2) review management guidelines that have been validated by appropriately conducted clinical research, and 3) identify gaps in current knowledge toward which future research can be directed.
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Lara-Cinisomo S, Swinford C, Massey D, Hardt H. Diabetes, Prenatal Depression, and Self-Rated Health in Latina Mothers. Diabetes Spectr 2018; 31:159-165. [PMID: 29773936 PMCID: PMC5951227 DOI: 10.2337/ds17-0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Latinas in the United States have elevated rates of diabetes and prenatal depression (PND). The presence of diabetes and PND can also have a negative effect on women's self-rated health (SRH), a commonly used indicator of health that is consistent with objective health status and is a predictor of mortality. However, the associations between PND, diabetes, and SRH have not been tested, particularly among Latinas, who have elevated risk of both medical conditions. To address this gap, this pilot study tested the association between PND and diabetes using data from Latinas enrolled during their third trimester of pregnancy and explored whether these health conditions were associated with SRH in these women. METHODS For this study, the Edinburgh Postnatal Depression Scale was used to determine PND status, self-reported medical history to determine diabetes status, and SRH before and during the current pregnancy in a sample of 34 prenatal Latinas. Participants were invited to take part in the study in their third trimester of pregnancy. Bivariate analyses and logistic regressions were used to test associations between demographic variables, PND, diabetes, and SRH. RESULTS There was no significant association between PND and diabetes status in this sample of Latinas. There was a significant difference in SRH from pre-pregnancy to pregnancy, with worse ratings reported during pregnancy. Furthermore, women with PND or diabetes reported worse SRH, even after controlling for pre-pregnancy SRH. CONCLUSION SRH is an important and robust variable associated with PND and diabetes in prenatal Latinas, making it an important factor to assess when treating this high-risk group.
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Affiliation(s)
- Sandraluz Lara-Cinisomo
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Claire Swinford
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Danielle Massey
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Heidi Hardt
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL
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Development of Perinatal Mental Illness in Women With Gestational Diabetes Mellitus: A Population-Based Cohort Study. Can J Diabetes 2017; 42:350-355.e1. [PMID: 28943221 DOI: 10.1016/j.jcjd.2017.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/13/2017] [Accepted: 08/03/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine the relationship between gestational diabetes mellitus (GDM) and the development of mental illness (affective and anxiety disorders) during pregnancy and 1 year postpartum. METHODS We linked clinical and administrative databases of mothers who delivered in Alberta, Canada, between April 1, 2000, and March 31, 2009, to identify diagnoses of GDM and mental illness. Women with prepregnancy type 1 or type 2 diabetes were excluded. We used generalized estimating equation models to examine the effect of GDM on the development of new-onset mental illness in 2 separate periods: during pregnancy and during the first postpartum year. Generalized estimating equation models were adjusted for age, overweight, smoking, rural residence, ethnicity, median household income, nulliparity, preeclampsia or eclampsia, neonatal death, infant neonatal intensive care unit stay, prior chronic medical conditions and fiscal year. RESULTS Of 326,723 pregnancies, 3.7% (12,140) were affected by GDM. Compared to women without GDM, women with GDM had a higher prevalence of, but did not have an increased risk for, new-onset mental illness during pregnancy (16.1% vs. 14.1%; OR 1.06, 95% CI 0.98 to 1.13) or postpartum (23.3% vs. 22.1%; OR 1.03, 95% CI 0.97, 1.10). CONCLUSIONS In this large population-based cohort of women in Alberta, GDM was not associated with an increased risk for developing new-onset mental illness during pregnancy or postpartum.
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13
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Orbay E, Tüzün S, Çınkıt B, Ölmez MB, Tekin S, Purut E, Bulut S, Sargın M. Gestasyonel Diabetes Mellitusu Olan Gebelerde Antenatal Anksiyete. ANKARA MEDICAL JOURNAL 2017. [DOI: 10.17098/amj.323187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lee SM, Park HJ. Relationship among Emotional Clarity, Maternal Identity, and Fetal Attachment in Pregnant Women with Gestational Diabetes Mellitus. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2017; 23:99-108. [PMID: 37684889 DOI: 10.4069/kjwhn.2017.23.2.99] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/11/2017] [Accepted: 04/19/2017] [Indexed: 09/10/2023] Open
Abstract
PURPOSE The purpose of this study was to examine the relationship among emotional clarity in emotional intelligence, maternal identity, and fetal attachment to measure how emotional clarity and maternal identity impact on fetal attachment and to determine mediating effects of maternal identity in pregnant women at the time of diagnosis with gestational diabetes mellitus (GDM). METHODS This study used a correlational survey design. 88 pregnant women with GDM completed a study questionnaire of emotional clarity, maternal identity, and fetal attachment immediately after the diagnosis of GDM. Data were analyzed Mann-Whitney U test, and ANOVA with Duncan test, Pearson correlation, three-step regressions to test mediating effect, and Sobel test. RESULTS The emotional clarity was positively related with maternal identity and fetal attachment. It affected maternal identity with 21.9% of explained variance. The emotional clarity and the maternal identity were significant predictors of fetal attachment by 57.7% of explained variance. The maternal identity mediated the relationship between emotional clarity and fetal attachment. CONCLUSION The results suggest that a nursing program to enhance the emotional clarity and the maternal identity needs to be developed as an effective strategy to improve fetal attachment.
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Engberg E, Tikkanen HO, Koponen A, Hägglund H, Kukkonen-Harjula K, Tiitinen A, Peltonen JE, Pöyhönen-Alho M. Cardiorespiratory fitness and health-related quality of life in women at risk for gestational diabetes. Scand J Med Sci Sports 2017; 28:203-211. [PMID: 28415143 DOI: 10.1111/sms.12896] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 12/16/2022]
Abstract
This study examined the associations of cardiorespiratory fitness (CRF) and leisure-time physical activity (LTPA) with health-related quality of life (HRQoL) in women at risk for gestational diabetes mellitus (GDM). The participants were 39 women planning pregnancy with a history of GDM and/or BMI >29 kg/m2 . We assessed CRF by measuring maximal oxygen consumption (VO2max ) during incremental cycle ergometer exercise until voluntary fatigue. LTPA was self-reported, and HRQoL assessed with the SF-36 Health Survey (SF-36). The mean (SD) VO2max was 27 (6) mL·kg-1 ·min-1 , and the mean LTPA was 2.6 (1.7) h/wk. After controlling for BMI, VO2max was positively associated with the SF-36 General Health scale (β 1.27, 95% CI: 0.09, 2.44, P=.035) and the Physical Component Summary (β 0.48, 95% CI: 0.14, 0.82, P=.007). The General Health scale (P=.023) and the Physical Component Summary (P=.011) differed even between those with very poor and poor CRF. After controlling for BMI, LTPA was positively associated with the SF-36 Physical Functioning scale (rs =.34, P=.039), the General Health scale (β 3.74, 95% CI: 0.64, 6.84, P=.020), and the Physical Component Summary (β 1.13 95% CI: 0.19, 2.06, P=.020). To conclude, CRF and LTPA were positively associated with perceived general health and physical well-being in women planning pregnancy and at risk for GDM. Even a slightly better CRF would be beneficial for well-being among women with low levels of CRF.
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Affiliation(s)
- E Engberg
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland.,Foundation for Sports and Exercise Medicine, Clinic for Sports and Exercise Medicine, Helsinki, Finland
| | - H O Tikkanen
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland.,Foundation for Sports and Exercise Medicine, Clinic for Sports and Exercise Medicine, Helsinki, Finland.,Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - A Koponen
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland.,Foundation for Sports and Exercise Medicine, Clinic for Sports and Exercise Medicine, Helsinki, Finland
| | - H Hägglund
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland.,Foundation for Sports and Exercise Medicine, Clinic for Sports and Exercise Medicine, Helsinki, Finland
| | - K Kukkonen-Harjula
- Rehabilitation, South Karelia Social and Health Care District (Eksote), Lappeenranta, Finland
| | - A Tiitinen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - J E Peltonen
- Department of Sports and Exercise Medicine, Clinicum, University of Helsinki, Helsinki, Finland.,Foundation for Sports and Exercise Medicine, Clinic for Sports and Exercise Medicine, Helsinki, Finland
| | - M Pöyhönen-Alho
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Rodrigues PB, Zambaldi CF, Cantilino A, Sougey EB. Special features of high-risk pregnancies as factors in development of mental distress: a review. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2017; 38:136-140. [PMID: 27737308 DOI: 10.1590/2237-6089-2015-0067] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 06/07/2016] [Indexed: 06/24/2024]
Abstract
Introduction: Approximately 22% of all pregnant women are classified as having high-risk pregnancies, which may involve feelings of vulnerability because of having a high-risk pregnancy, resulting in greater exposure to stressful feelings. Objective: To review aspects of high-risk pregnancy that can have a negative impact on the these women's mental health status. Method: Original articles were identified by conducting searches of the PubMed/MEDLINE, LILACS and SciELO databases, followed by a manual search of references to select articles and additional bibliographic material. Articles from the last 22 years were included in the review (1992-2014). Results: Fifteen articles were found that specifically studied high-risk pregnancies and mental health outcomes. Women with high-risk pregnancies exhibited a significantly higher level of stress and reported negative emotions as they dealt with stress and had worse emotional status than women with normal pregnancies. Researchers found that hospitalized pregnant women had higher levels of anxiety than non-hospitalized women. Studies of women going through normal and high-risk pregnancies show that women with normal pregnancies had good self-perceived quality of life. Conclusion: Special features of high-risk pregnancies could be factors in development of mental distress, in addition to psychological and social factors. Therefore, only a biopsychosocial research study would be able to identify the factors that can affect the quality of mental health during high-risk pregnancy.
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Affiliation(s)
- Paula Borba Rodrigues
- Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Carla Fonseca Zambaldi
- Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Amaury Cantilino
- Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
| | - Everton Botelho Sougey
- Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil
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Marchetti D, Carrozzino D, Fraticelli F, Fulcheri M, Vitacolonna E. Quality of Life in Women with Gestational Diabetes Mellitus: A Systematic Review. J Diabetes Res 2017; 2017:7058082. [PMID: 28326332 PMCID: PMC5343261 DOI: 10.1155/2017/7058082] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/09/2017] [Indexed: 12/16/2022] Open
Abstract
Background and Objective. Diagnosis of Gestational Diabetes Mellitus (GDM) could significantly increase the likelihood of health problems concerning both potential risks for the mother, fetus, and child's development and negative effects on maternal mental health above all in terms of a diminished Quality of Life (QoL). The current systematic review study is aimed at further contributing to an advancement of knowledge about the clinical link between GDM and QoL. Methods. According to PRISMA guidelines, PubMed, Web of Science, Scopus, and Cochrane databases were searched for studies aimed at evaluating and/or improving levels of QoL in women diagnosed with GDM. Results. Fifteen research studies were identified and qualitatively analyzed by summarizing results according to the following two topics: GDM and QoL and interventions on QoL in patients with GDM. Studies showed that, in women with GDM, QoL is significantly worse in both the short term and long term. However, improvements on QoL can be achieved through different intervention programs by enhancing positive diabetes-related self-management behaviors. Conclusion. Future studies are strongly recommended to further examine the impact of integrative programs, including telemedicine and educational interventions, on QoL of GDM patients by promoting their illness acceptance and healthy lifestyle behaviors.
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Affiliation(s)
- Daniela Marchetti
- Department of Psychological Health and Territorial Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Danilo Carrozzino
- Department of Psychological Health and Territorial Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Federica Fraticelli
- Department of Medicine and Aging, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Mario Fulcheri
- Department of Psychological Health and Territorial Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
| | - Ester Vitacolonna
- Department of Medicine and Aging, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
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Ross GP, Falhammar H, Chen R, Barraclough H, Kleivenes O, Gallen I. Relationship between depression and diabetes in pregnancy: A systematic review. World J Diabetes 2016; 7:554-571. [PMID: 27895824 PMCID: PMC5107715 DOI: 10.4239/wjd.v7.i19.554] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/20/2016] [Accepted: 06/14/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To systematically review the literature on women with both diabetes in pregnancy (DIP) and depression during or after pregnancy. METHODS In this systematic literature review, PubMed/MEDLINE and EMBASE were searched (13 November 2015) using terms for diabetes (type 1, type 2, or gestational), depression, and pregnancy (no language or date restrictions). Publications that reported on women who had both DIP (any type) and depression or depressive symptoms before, during, or within one year after pregnancy were considered for inclusion. All study types were eligible for inclusion; conference abstracts, narrative reviews, nonclinical letters, editorials, and commentaries were excluded, unless they provided treatment guidance. RESULTS Of 1189 articles identified, 48 articles describing women with both DIP and depression were included (sample sizes 36 to > 32 million). Overall study quality was poor; most studies were observational, and only 12 studies (mostly retrospective database studies) required clinical depression diagnosis. The prevalence of concurrent DIP (any type) and depression in general populations of pregnant women ranged from 0% to 1.6% (median 0.61%; 12 studies). The prevalence of depression among women with gestational diabetes ranged from 4.1% to 80% (median 14.7%; 16 studies). Many studies examined whether DIP was a risk factor for depression or depression was a risk factor for DIP. However, there was no clear consensus for either relationship. Importantly, we found limited guidance on the management of women with both DIP and depression. CONCLUSION Given the increasing prevalence of diabetes and depression, high-quality research and specific guidance for management of pregnant women with both conditions are warranted.
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Sayakhot P, Carolan-Olah M. Sources of information on Gestational Diabetes Mellitus, satisfaction with diagnostic process and information provision. BMC Pregnancy Childbirth 2016; 16:287. [PMID: 27679990 PMCID: PMC5041326 DOI: 10.1186/s12884-016-1067-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 09/13/2016] [Indexed: 01/30/2023] Open
Abstract
Background This study aimed to investigate the percentage of the needs and expectations of pregnant women with Gestational Diabetes Mellitus (GDM) about the best sources of information on GDM, their satisfaction with the diagnostic process and information provision. Methods Questionnaires were completed by 116 pregnant women aged 18–45 years, diagnosed with GDM and recruited from maternity diabetes clinic. Eligible women were invited to participate in the study and informed consent was obtained from each participant prior to enrolment. Descriptive statistics, Kruskal-Wallis test, t-test and chi-square test were used to analyse data. Results Most women (64.2 %) expected general practitioners (GPs) to be the best source of GDM information, following by diabetes educator nurses (45.9 %), diabetes support groups (33.9 %) and internet (32.1 %). However, women found that diabetes educator nurses were more helpful than GPs (32.6 and 20.2 %, respectively). Participants’ age and country of birth were statistically significant. For women aged over 30 years and women born overseas the internet was the most useful information source (68.9 and 77.1 % respectively). Overall, women were very satisfied (33.0 %) or satisfied (45.0 %) with how they were informed of the GDM diagnosis, although 26.0 % were informed by telephone and 16.0 % by text message. More than one-third (39.0 %) of women were not referred to sources of information by GPs at time of diagnosis of GDM (p <0.0001). Women who were referred reported that they were very satisfied (40.0 %) or satisfied (44.0 %) with information they received. Only 8.0 % of women reported dissatisfaction with the manner of health professionals. Conclusion The results suggest that health professionals should be aware of the needs and expectations of women who have been diagnosed with GDM, with most women expecting to receive information on GDM from their GPs and diabetes educator nurses. The findings suggest that there is scope for improving how women are informed of the GDM diagnosis and given information, and in clinicians’ manner.
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Affiliation(s)
- Padaphet Sayakhot
- St Albans Campus, College of Health and Biomedicine, Victoria University, Building 4C, McKechnie Street, St Albans, VIC, 3021, Australia.
| | - Mary Carolan-Olah
- St Albans Campus, College of Health and Biomedicine, Victoria University, Building 4C, McKechnie Street, St Albans, VIC, 3021, Australia
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Hannan J, Brooten D, Youngblut JM, Galindo AM. Comparing mothers' postpartum concerns in two clinical trials 18 years apart. J Am Assoc Nurse Pract 2016; 28:604-611. [PMID: 27273192 DOI: 10.1002/2327-6924.12384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 04/05/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND PURPOSE To determine if U.S. women's postpartum concerns have changed over time. METHODS Mothers' postpartum concerns were compared in two clinical trials: 1997 (high-risk pregnancy) and 2015 (first-time mothers). Advanced practice nurses (APNs) provided care through 8 weeks postpartum and recorded interactions in clinical logs. Content analysis of logs was used for identifying concerns. RESULTS Ninety-five percent of 58 1997 mothers were African American; 64% of 62 2015 mothers were Hispanic. The number of infant concerns (129 vs. 144) was similar to four of the top five infant concerns; infant feeding was the top concern for both groups. The 1997 mothers were concerned with body changes, birth control, breastfeeding, maternal health problems, and had more concerns about their health (142 vs. 43); the 2015 mothers were concerned with not having help, fatigue, finding things hard. Both groups had postpartum pain concerns and problems accessing mother/infant governmental programs. CONCLUSIONS Mothers' concerns regarding infant care were essentially the same over the two time periods with infant feeding as the top concern. Maternal concerns in common were postpartum pain and needing help accessing government programs. Women who had high-risk pregnancies had more health concerns. IMPLICATIONS FOR PRACTICE Results provide guidance for helping minority mothers in the postpartum period.
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Affiliation(s)
- Jean Hannan
- Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida
| | - Dorothy Brooten
- Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida
| | | | - Ali Marie Galindo
- Nicole Wertheim College of Nursing and Health Sciences, Miami, Florida
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Benhalima K, Damm P, Van Assche A, Mathieu C, Devlieger R, Mahmood T, Dunne F. Screening for gestational diabetes in Europe: where do we stand and how to move forward?: A scientific paper commissioned by the European Board & College of Obstetrics and Gynaecology (EBCOG). Eur J Obstet Gynecol Reprod Biol 2016; 201:192-6. [PMID: 27105781 DOI: 10.1016/j.ejogrb.2016.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/10/2016] [Indexed: 10/22/2022]
Abstract
The incidence of gestational diabetes (GDM) is rising globally and it represents an important modifiable risk factor for adverse pregnancy outcomes. GDM is also associated with negative long-term health outcomes for both mothers and offspring. Acceptance and implementation of the 2013 World Health Organization (WHO) criteria varies globally and within Europe. There is at present no consensus on the optimal approach to GDM screening in Europe. More uniformity in GDM screening across Europe will lead to an opportunity for more timely diagnosis and treatment for GDM in a greater number of women. More targeted research is necessary to evaluate optimal screening strategies based on the 2013 WHO criteria across different European populations with a focus on implementation strategy. Future research should address these important questions so that solid recommendations for GDM screening can be made to European health organizations based on screening uptake rates, maternal well-being, maternal and neonatal health outcomes, equity and cost-effectiveness. Here we describe the ongoing controversy on GDM screening and diagnosis, and provide an overview of important topics for future research concerning GDM screening in Europe.
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Affiliation(s)
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, The Clinical Institute of Medicine, Faculty of Health and Medicine Sciences, University of Copenhagen, Denmark
| | - André Van Assche
- Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, UZ Gasthuisberg, KU Leuven, Belgium
| | - Roland Devlieger
- Department of Obstetrics & Gynecology, UZ Gasthuisberg, KU Leuven, Belgium
| | - Tahir Mahmood
- Department of Obstetrics & Gynecology, Victoria Hospital, Kirkcaldy, Scotland, UK
| | - Fidelma Dunne
- Endocrinology School of Medicine and Galway Diabetes Research Centre (GDRC), National University of Ireland, Galway (NUIG), Ireland
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22
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Senat MV, Deruelle P. [Gestational diabetes mellitus]. ACTA ACUST UNITED AC 2016; 44:244-7. [PMID: 26948827 DOI: 10.1016/j.gyobfe.2016.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/17/2015] [Indexed: 12/16/2022]
Abstract
While the prevalence of gestational diabetes mellitus (GDM) was estimated between 5 and 10% in 2010, the application of new thresholds recommended by IADPSG and adopted in 2010 by CNGOF seems to significantly increase the number of patients affected by this pathology. A prospective single-center French study estimated in 2014 the prevalence of gestational diabetes at 14% with these criteria, making it one of the most frequent complications during pregnancy. However, to date, there is no published study using these criteria to show a benefit to the health of women and children. If a diagnosis of GDM or type 2 diabetes during pregnancy is definitively an important risk factor for maternal as well as newborn and child complications, it is probably not the case for moderate hyperglycemia discovered during pregnancy.
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Affiliation(s)
- M-V Senat
- Service gynécologie obstétrique, hôpital Bicêtre, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France.
| | - P Deruelle
- EA 4489, environnement périnatal et croissance, pôle recherche, faculté de médecine Henri-Warembourg, université Lille 2, 59045 Lille cedex, France
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Bartolo S, Vambergue A, Deruelle P. [Screening for gestational diabetes: Still many unsolved issues]. ACTA ACUST UNITED AC 2016; 45:105-11. [PMID: 26780845 DOI: 10.1016/j.jgyn.2015.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/25/2015] [Accepted: 12/16/2015] [Indexed: 12/13/2022]
Abstract
For many years, there is a debate on gestational diabetes screening, including what screening test and thresholds to use. The purpose of this literature review is to determine whether gestational diabetes screening in France meets the 10 definition criteria of the WHO. The DG is a public health problem, with a natural history partially known and detectable at an early stage. Currently, there is no data showing that there is a benefit to treat patient screens by the new criteria. The one-step approach-screening test can only detect fetal complications and not maternal complications. It seems to be acceptable for the population of pregnant women. The diagnostic test and treatment also seem to be acceptable to us. To this day, its reproducibility is uncertain. Screening leads to an increase in obstetric interventions. Several studies found that screening for gestational diabetes is cost-effective but in a different context of care than in France.
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Affiliation(s)
- S Bartolo
- Clinique d'obstétrique, pôle femme-mère-nouveau-né, CHU de Lille, 59037 Lille cedex, France.
| | - A Vambergue
- Pôle d'endocrinologie, CHU de Lille, 59037 Lille cedex, France; UMR 8199, université Lille 2, EGID, 59037 Lille cedex, France
| | - P Deruelle
- Clinique d'obstétrique, pôle femme-mère-nouveau-né, CHU de Lille, 59037 Lille cedex, France; EA 4489, environnement périnatal et santé, CHU de Lille, université de Lille, 59000 Lille, France
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Bień A, Rzońca E, Kańczugowska A, Iwanowicz-Palus G. Factors Affecting the Quality of Life and the Illness Acceptance of Pregnant Women with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010068. [PMID: 26703697 PMCID: PMC4730459 DOI: 10.3390/ijerph13010068] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Revised: 12/09/2015] [Accepted: 12/11/2015] [Indexed: 12/16/2022]
Abstract
The paper contains an analysis of the factors affecting the quality of life (QoL) and the illness acceptance of diabetic pregnant women. The study was performed between January and April, 2013. It included 114 pregnant women with diabetes, hospitalized in the High Risk Pregnancy Wards of several hospitals in Lublin, Poland. The study used a diagnostic survey with questionnaires. The research instruments used were: The WHOQOL-Bref questionnaire and the Acceptance of Illness Scale (AIS). The women’s general quality of life was slightly higher than their perceived general health. A higher quality of life was reported by women with a very good financial standing, very good perceived health, moderate self-reported knowledge of diabetes, and also by those only treated with diet and stating that the illness did not interfere with their lives (p < 0.05). Women with a very good financial standing (p < 0.009), high self-reported health (p < 0.002), and those treated with by means of a diet (p < 0.04) had a higher acceptance of illness. A higher acceptance of illness contributes to a higher general quality of life and a better perception of one’s health.
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Affiliation(s)
- Agnieszka Bień
- Independent Obstetric Skills Unit, Faculty of Health Sciences, Medical University of Lublin, 4 Staszica St., 20-081 Lublin, Poland.
| | - Ewa Rzońca
- Independent Obstetric Skills Unit, Faculty of Health Sciences, Medical University of Lublin, 4 Staszica St., 20-081 Lublin, Poland.
| | - Angelika Kańczugowska
- Neonatology Ward, Independent Public Teaching Hospital No. 4 in Lublin, 8 Jaczewskiego St., 20-954 Lublin, Poland.
| | - Grażyna Iwanowicz-Palus
- Independent Obstetric Skills Unit, Faculty of Health Sciences, Medical University of Lublin, 4 Staszica St., 20-081 Lublin, Poland.
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Kolu P, Raitanen J, Luoto R. Physical activity and health-related quality of life during pregnancy: a secondary analysis of a cluster-randomised trial. Matern Child Health J 2015; 18:2098-105. [PMID: 24585400 DOI: 10.1007/s10995-014-1457-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the study was to evaluate the role of physical activity before and during pregnancy on health-related quality of life (HRQoL). Data from the cluster-randomised gestational diabetes mellitus primary prevention trial conducted in maternity clinics were utilised in a secondary analysis. The cases considered were pregnant women who reported engaging in at least 150 min of moderate-intensity leisure-time physical activity per week (active women) (N = 80), and the controls were women below these recommendations (less active) (N = 258). All participants had at least one risk factor for gestational diabetes mellitus. Their HRQoL was evaluated via the validated generic instrument 15D, with HRQoL at the end of pregnancy examined in relation to changes in physical activity during pregnancy. Logistic regression models addressed age, parity, education, and pre-pregnancy body mass index. At the end of pregnancy, the expected HRQoL was higher (tobit regression coefficient 0.022, 95 % CI 0.003-0.042) among active women than less active women. Active women also had greater mobility (OR 1.98, 95 % CI 1.04-3.78), ability to handle their usual activities (OR 2.22, 95 % CI 1.29-3.81), and vitality (OR 2.08, 95 % CI 1.22-3.54) than did less active women. Active women reported higher-quality sleep (OR 2.11, 95 % CI 1.03-4.30) throughout pregnancy as compared to less active women. Meeting of the physical activity guidelines before pregnancy was associated with better overall HRQoL and components thereof related to physical activity.
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Affiliation(s)
- Päivi Kolu
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, 33501, Tampere, Finland,
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Danyliv A, Gillespie P, O'Neill C, Noctor E, O'Dea A, Tierney M, McGuire BE, Glynn LG, Dunne FP. Health related quality of life two to five years after gestational diabetes mellitus: cross-sectional comparative study in the ATLANTIC DIP cohort. BMC Pregnancy Childbirth 2015; 15:274. [PMID: 26496985 PMCID: PMC4619994 DOI: 10.1186/s12884-015-0705-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/14/2015] [Indexed: 12/26/2022] Open
Abstract
Background There is no consensus on the effect of gestational diabetes mellitus (GDM) on health-related quality of life (HRQOL) for the mother in the short or long term. In this study we examined HRQOL in a group of women who had GDM in the index pregnancy 2 to 5 years previously and compared it to a group of women with normal glucose tolerance (NGT) in the index pregnancy during the same time period. Methods The sample included 234 women who met International Association of Diabetes Study Groups (IADPSG) criteria for GDM in the index pregnancy and 108 who had NGT. The sample was drawn from the ATLATIC-DIP (Diabetes In Pregnancy) cohort – a network of antenatal centers along the Irish Atlantic seaboard serving a population of approximately 500,000 people. HRQOL was measured using the visual analogue component of the EQ-5D-3 L instrument in a cross-sectional survey. Results The difference in HRQOL between GDM and NGT groups was not significant when adjusted for the effects of the covariates. HRQOL was negatively affected by increased BMI and abnormal glucose tolerance post-partum in the NGT group. Moderate alcohol consumption was positively associated with HRQOL in the NGT group only. The negative association with smoking on HRQOL was substantially higher in the GDM group. Conclusions A diagnosis of GDM does not appear to have an adverse effect on HRQOL, 2 to 5 years after the index pregnancy. On the contrary, its diagnosis might lead to the development of coping strategies, which, consequently attenuates the adverse effect of the subsequent acquisition of abnormal glucose tolerance post-partum on HRQOL. Women whose pregnancy was affected by GDM are more susceptible to the adverse effects on HRQOL of alcohol use and tobacco smoking. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0705-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andriy Danyliv
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland. .,School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.
| | - Paddy Gillespie
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland.
| | - Ciaran O'Neill
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland.
| | - Eoin Noctor
- School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland.
| | - Angela O'Dea
- School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. .,Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
| | - Marie Tierney
- School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. .,Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
| | - Brian E McGuire
- School of Psychology, National University of Ireland, Galway, Ireland. .,Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
| | - Liam G Glynn
- Discipline of General Practice, National University of Ireland, Galway, Ireland.
| | - Fidelma P Dunne
- School of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland. .,Galway Diabetes Research Centre, National University of Ireland Galway, Galway, Ireland.
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Walmer R, Huynh J, Wenger J, Ankers E, Mantha AB, Ecker J, Thadhani R, Park E, Bentley-Lewis R. MENTAL HEALTH DISORDERS SUBSEQUENT TO GESTATIONAL DIABETES MELLITUS DIFFER BY RACE/ETHNICITY. Depress Anxiety 2015; 32:774-82. [PMID: 26130074 DOI: 10.1002/da.22388] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 04/02/2015] [Accepted: 05/16/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION The relationship between gestational diabetes mellitus (GDM) and postpregnancy mental health disorders has been inconsistently reported. Additionally, race/ethnicity data are limited. We sought to elucidate the intersection of these relationships. METHODS We analyzed 18,109 women aged 18-40 with self-reported race/ethnicity. Women with (n = 659) and without (n = 14,461) GDM were followed for a median of 4.4 (interquartile range 1.4-6.8) and 4.0 (1.5-6.4) years, respectively, for incident mental health disorders. Multivariable repeated measures analyses were conducted to examine associations between GDM and postpregnancy mental health disorders, race/ethnicity, and the interaction of these factors. RESULTS Women with compared to women without GDM were older (mean ± standard deviation, 32 ± 5 vs. 30 ± 5 years; P < .001) and had higher body mass index (29.0 ± 7.2 vs. 25.3 ± 5.2 kg/m(2) ; P < .001). GDM was associated with increased risk for depression and anxiety after adjusting for age and pregnancy complications; however, loss of significance in the fully adjusted model for depression (odds ratio [95% CI]: 1.29 [0.98, 1.70]; P = .064) and anxiety (1.14 [0.83, 1.57], P = .421) suggested that clinical and socioeconomic factors influence this relationship. Hispanic compared to white women had a greater risk for depression (1.40 [1.15, 1.72]; P = .001), even after multivariable adjustment. The interaction between GDM and race was evident in complication-adjusted but not fully adjusted models. CONCLUSIONS The incidence of mental health disorders subsequent to GDM was attenuated after adjustment for clinical and socioeconomic factors. Moreover, race/ethnicity influenced this relationship. Further investigation is warranted to clarify potential underlying mechanisms.
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Affiliation(s)
- Rebecca Walmer
- Medicine/Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer Huynh
- Medicine/Diabetes Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Julia Wenger
- Medicine/Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth Ankers
- Medicine/Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Jeffrey Ecker
- Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ravi Thadhani
- Medicine/Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elyse Park
- Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital, Boston, Massachusetts
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Han S, Middleton PF, Bubner TK, Crowther CA. Women's views on their diagnosis and management for borderline gestational diabetes mellitus. J Diabetes Res 2015; 2015:209215. [PMID: 25785278 PMCID: PMC4345277 DOI: 10.1155/2015/209215] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/07/2015] [Accepted: 01/11/2015] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Little is known about women's views relating to a diagnosis of borderline gestational diabetes mellitus (GDM) and the subsequent management. This study aimed to explore women's experiences after being diagnosed with borderline GDM, their attitudes about treatment, and factors important to them for achieving any lifestyle changes. METHODS We conducted face-to-face, semistructured interviews with women diagnosed with borderline GDM. RESULTS A total of 22 women were interviewed. After a diagnosis of borderline GDM, 14 (64%) women reported not being concerned or worried. Management of borderline GDM was thought by 21 (95%) women to be very important or important. Eighteen (82%) women planned to improve their diet and/or exercise to manage their borderline GDM. The most frequently mentioned enabler for achieving intended lifestyle change was being more motivated to improve the health of their baby and/or themselves (15 women). The most frequent barrier was tiredness and/or being physically unwell (11 women). CONCLUSIONS A diagnosis of borderline GDM caused some concern to one-third of women interviewed. The majority of women believed managing their borderline GDM was important and they planned to improve their lifestyle. Women's own and their babies' future health were powerful motivators for lifestyle change.
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Affiliation(s)
- Shanshan Han
- Australian Research Centre for Health of Women and Babies (ARCH), The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, SA 5006, Australia
| | - Philippa F. Middleton
- Australian Research Centre for Health of Women and Babies (ARCH), The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, SA 5006, Australia
| | - Tanya K. Bubner
- Australian Research Centre for Health of Women and Babies (ARCH), The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, SA 5006, Australia
| | - Caroline A. Crowther
- Australian Research Centre for Health of Women and Babies (ARCH), The Robinson Research Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Adelaide, SA 5006, Australia
- Liggins Institute, The University of Auckland, Auckland 1023, New Zealand
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Satisfaction with diagnosis process for gestational diabetes mellitus and risk perception among Australian women. Int J Gynaecol Obstet 2015; 129:46-9. [DOI: 10.1016/j.ijgo.2014.10.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/25/2014] [Accepted: 12/19/2014] [Indexed: 01/28/2023]
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Farrar D, Fairley L, Wright J, Tuffnell D, Whitelaw D, Lawlor DA. Evaluation of the impact of universal testing for gestational diabetes mellitus on maternal and neonatal health outcomes: a retrospective analysis. BMC Pregnancy Childbirth 2014; 14:317. [PMID: 25199524 PMCID: PMC4167281 DOI: 10.1186/1471-2393-14-317] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 08/11/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Gestational diabetes (GDM) affects a substantial proportion of women in pregnancy and is associated with increased risk of adverse perinatal and long term outcomes. Treatment seems to improve perinatal outcomes, the relative effectiveness of different strategies for identifying women with GDM however is less clear.This paper describes an evaluation of the impact of a change in policy from selective risk factor based offering, to universal offering of an oral glucose tolerance test (OGTT) to identify women with GDM on maternal and neonatal outcomes. METHODS Retrospective six year analysis of 35,674 births at the Women's and Newborn unit, Bradford Royal Infirmary, United Kingdom. RESULTS The proportion of the whole obstetric population diagnosed with GDM increased almost fourfold following universal offering of an OGTT compared to selective offering of an OGTT; Rate Ratio (RR) 3.75 (95% CI 3.28 to 4.29), the proportion identified with severe hyperglycaemia doubled following the policy change; 1.96 (1.50 to 2.58). The case detection rate however, for GDM in the whole population and severe hyperglycaemia in those with GDM reduced by 50-60%; 0.40 (0.35 to 0.46) and 0.51 (0.39 to 0.67) respectively. Universally offering an OGTT was associated with an increased induction of labour rate in the whole obstetric population and in women with GDM; 1.43 (1.35 to 1.50) and 1.21 (1.00 to1.49) respectively. Caesarean section, macrosomia and perinatal mortality rates in the whole population were similar. For women with GDM, rate of caesarean section; 0.70 (0.57 to 0.87), macrosomia; 0.22 (0.15 to 0.34) and perinatal mortality 0.12 (0.03 to 0.46) decreased following the policy change. CONCLUSIONS Universally offering an OGTT was associated with increased identification of women with GDM and severe hyperglycaemia and with neonatal benefits for those with GDM. There was no evidence of benefit or adverse effects in neonatal outcomes in the whole obstetric population.
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Affiliation(s)
- Diane Farrar
- />Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Lesley Fairley
- />Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - John Wright
- />Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Derek Tuffnell
- />Women’s and Newborn Unit, Bradford Royal Infirmary, Bradford, UK
| | - Donald Whitelaw
- />Women’s and Newborn Unit, Bradford Royal Infirmary, Bradford, UK
| | - Debbie A Lawlor
- />MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, UK
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Hui AL, Sevenhuysen G, Harvey D, Salamon E. Stress and Anxiety in Women With Gestational Diabetes During Dietary Management. DIABETES EDUCATOR 2014; 40:668-77. [DOI: 10.1177/0145721714535991] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose To explore the stress and anxiety experiences during dietary management in women with gestational diabetes (GDM). Methods Thirty women with GDM from the Winnipeg area participated in the mixed methods study. Each participant completed a Food Choice Map semistructured interview, a Perceived Stress Scale, a Pregnancy Anxiety Scale, a State-Trait Anxiety Inventory–Trait questionnaire, and a demographic questionnaire. Stress and anxiety experiences were identified from interview transcripts and categorized into themes based on the constant comparative method. Questionnaire scores aided in interpreting the stress and anxiety experience in the qualitative data. Results Three major themes were generated from the interviews: (1) stress related to GDM diagnosis and the perception of a high risk pregnancy; (2) stress over losing control of GDM during the process of dietary management; and (3) anxiety related to the fear of maternal and infant complications. Women on insulin experienced significantly higher levels of perceived stress ( P < .01), and the dietary management stress was more prevalent in women using insulin compared to the ones on diet treatment only (Fisher exact test, P < .01). Unhealthy diet coping strategies occurred with the stress and anxiety. Conclusions Stress and anxiety were associated with different contexts in this study sample. Women who were on insulin experienced significantly higher levels of perceived stress related to dietary management.
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Affiliation(s)
- Amy Leung Hui
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (Ms Hui, Dr Salamon)
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Sevenhuysen, Dr Harvey)
| | - Gustaaf Sevenhuysen
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (Ms Hui, Dr Salamon)
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Sevenhuysen, Dr Harvey)
| | - Dexter Harvey
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (Ms Hui, Dr Salamon)
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Sevenhuysen, Dr Harvey)
| | - Elizabeth Salamon
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada (Ms Hui, Dr Salamon)
- Department of Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada (Dr Sevenhuysen, Dr Harvey)
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Colagiuri S, Falavigna M, Agarwal MM, Boulvain M, Coetzee E, Hod M, Meltzer SJ, Metzger B, Omori Y, Rasa I, Schmidt MI, Seshiah V, Simmons D, Sobngwi E, Torloni MR, Yang HX. Strategies for implementing the WHO diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Diabetes Res Clin Pract 2014; 103:364-72. [PMID: 24731475 DOI: 10.1016/j.diabres.2014.02.012] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2013] [Indexed: 02/07/2023]
Abstract
The World Health Organization (WHO) has recently released updated recommendations on Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy which are likely to increase the prevalence of gestational diabetes mellitus (GDM). Any increase in the number of women with GDM has implications for health services since these women will require treatment and regular surveillance during the pregnancy. Some health services throughout the world may have difficulty meeting these demands since country resources for addressing the diabetes burden are finite and resource allocation must be prioritised by balancing the need to improve care of people with diabetes and finding those with undiagnosed diabetes, including GDM. Consequently each health service will need to assess their burden of hyperglycaemia in pregnancy and decide if and how it will implement programmes to test for and treat such women. This paper discusses some considerations and options to assist countries, health services and health professionals in these deliberations.
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Affiliation(s)
- Stephen Colagiuri
- Boden Institute of Obesity, Nutrition and Exercise, The University of Sydney, Sydney, Australia.
| | - Maicon Falavigna
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mukesh M Agarwal
- Faculty of Medicine, UAE University, Al Ain, United Arab Emirates
| | - Michel Boulvain
- Service d'Obstétrique Maternité HUG, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Edward Coetzee
- Department Obstetrics & Gynaecology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tiqva, Tel-Aviv, Israel
| | - Sara J Meltzer
- Department of Medicine, McGill University, Montreal, Canada; Department of Obstetrics and Gynaecology, McGill University, Montreal, Canada
| | - Boyd Metzger
- Northwestern University, Feinberg School of Medicine, Chicago, United States
| | - Yasue Omori
- Tokyo Women's Medical University, Diabetes Center, Ebina General Hospital, Tokyo, Japan
| | - Ingvars Rasa
- Rīga East Clinical University Hospital, Rīga Stradiņš University, Rīga, Latvia
| | - Maria Inês Schmidt
- Post Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Veerasamy Seshiah
- Diabetes Research Institute, Dr Balaji Diabetes Care Centre, Chennai, India
| | - David Simmons
- Institute of Metabolic Science, Cambridge University Hospitals, National Health Services Foundation Trust, Cambridge, United Kingdom
| | - Eugene Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Cameroon; Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | | | - Hui-xia Yang
- Peking University First Hospital, Beijing, China
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Tieu J, McPhee AJ, Crowther CA, Middleton P. Screening and subsequent management for gestational diabetes for improving maternal and infant health. Cochrane Database Syst Rev 2014:CD007222. [PMID: 24515533 DOI: 10.1002/14651858.cd007222.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a form of diabetes that occurs in pregnancy. Although GDM usually resolves following birth, it is associated with significant morbidities for mother and baby both perinatally and in the long term. There is strong evidence to support treatment for GDM. However, there is little consensus on whether or not screening for GDM will improve maternal and infant health and if so, the most appropriate protocol to follow. OBJECTIVES To assess the effects of different methods of screening for GDM and maternal and infant outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (1 December 2013). SELECTION CRITERIA Randomised and quasi-randomised trials evaluating the effects of different methods of screening for GDM. DATA COLLECTION AND ANALYSIS Two review authors independently conducted data extraction and quality assessment. We resolved disagreements through discussion or through a third author. MAIN RESULTS We included four trials involving 3972 women in the review. One quasi-randomised trial compared risk factor screening with universal or routine screening by 50 g oral glucose challenge testing. Women in the universal screening group were more likely to be diagnosed with GDM (one trial, 3152 women, risk ratio (RR) 0.44, 95% confidence interval (CI) 0.26 to 0.75). This trial did not report on the other primary outcomes of the review (positive screen for GDM, mode of birth, large-for-gestational age, or macrosomia). Considering secondary outcomes, infants of mothers in the risk factor screening group were born marginally earlier than infants of mothers in the routine screening group (one trial, 3152 women, mean difference (MD) -0.15 weeks, 95% CI -0.27 to -0.03).The remaining three trials evaluated different methods of administering a 50 g glucose load. Two small trials compared glucose monomer with glucose polymer testing, with one of these trials including a candy bar group. One trial compared a glucose solution with food. No differences in diagnosis of GDM were found between each comparison. However, in one trial significantly more women in the glucose monomer group screened positive for GDM than women in the candy bar group (80 women, RR 3.49, 95% CI 1.05 to 11.57). The three trials did not report on the primary review outcomes of mode of birth, large-for-gestational age or macrosomia. Overall, women drinking the glucose monomer experienced fewer side effects from testing than women drinking the glucose polymer (two trials, 151 women, RR 2.80, 95% CI 1.10 to 7.13). However, we observed substantial heterogeneity between the trials for this result (I² = 61%). AUTHORS' CONCLUSIONS There was insufficient evidence to determine if screening for gestational diabetes, or what types of screening, can improve maternal and infant health outcomes.
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Affiliation(s)
- Joanna Tieu
- ARCH: Australian Research Centre for Health of Women and Babies, The Robinson Institute, Discipline of Obstetrics and Gynaecology, The University of Adelaide, Women's and Children's Hospital, 1st floor, Queen Victoria Building, 72 King William Road, Adelaide, South Australia, Australia, 5006
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Chamberlain C, Fredericks B, Davis B, Mein J, Smith C, Eades S, Oldenburg B. Postpartum care for Aboriginal and non-Aboriginal women with Gestational Diabetes Mellitus across urban, rural and remote locations: a protocol for a cohort linkage study. SPRINGERPLUS 2013; 2:576. [PMID: 25674406 PMCID: PMC4320232 DOI: 10.1186/2193-1801-2-576] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/28/2013] [Indexed: 12/23/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is increasing, along with obesity and type 2 diabetes (T2DM), with Aboriginal and Torres Strait Islander (Aboriginal(a)) women in Australia particularly affected. GDM causes serious complications in pregnancy, birth, and the longer term, for women and their infants. Women with GDM have an eightfold risk of developing T2DM after pregnancy, compared to women without GDM. Indigenous women have an even higher risk, at a younger age, and progress more quickly from GDM to T2DM, compared to non-Indigenous women. If left undetected and untreated, T2DM increases risks in subsequent pregnancies, and can lead to heart disease, stroke, kidney failure, limb amputations and blindness for the woman in the longer term. A GDM diagnosis offers a 'window of opportunity' to provide acceptable and effective prevention, treatment, and postpartum care. Low rates of postpartum T2DM screening are reported among non-Aboriginal women in Australia and Indigenous women in other countries, however, data for Aboriginal women in Australia are scarce. A healthy diet, exercise and breastfeeding can delay the onset of T2DM, and together with T2DM screening are recommended elements of postpartum care for women with GDM. This paper describes methods for a study evaluating postpartum care among Aboriginal and non-Aboriginal women with GDM. METHODS/DESIGN This retrospective cohort includes all women who gave birth at Cairns Hospital in far north Queensland, Australia, from 2004 to 2010, coded as having GDM in the Cairns Hospital Clinical Coding system. Data is being linked with the Midwives Perinatal Data Collection, and the three local laboratories. Hospital medical records are being reviewed to validate accuracy of GDM case ascertainment, and gather information on breastfeeding and provision of dietary advice. Survival analysis is being used to estimate time to screening, and rates of progression from GDM to T2DM. Logistic regression is being used to compare postpartum care between Aboriginal and non-Aboriginal women, and assess factors that may be associated with provision of postpartum care. DISCUSSION There are challenges to collecting postpartum data for women with GDM, however, this research is urgently needed to ensure adequate postpartum care is provided for women with GDM.
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Affiliation(s)
- Catherine Chamberlain
- Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, L3/89 Commercial Rd, Prahan, Victoria, 3181 Australia
| | - Bronwyn Fredericks
- Office of Indigenous Engagement, Central Queensland University, Bruce Highway, North Rockhampton, Queensland, 4701 Australia
| | - Bronwyn Davis
- Cairns Diabetes Centre, PO Box 902, Cairns, Queensland 4870 Australia
| | - Jacqueline Mein
- Apunipima Cape York Health Council, 186 McCoombe Street, Cairns, Queensland 4870 Australia
| | - Catherine Smith
- Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, L6/96 Commercial Rd, Prahan, Victoria, 3181 Australia
| | - Sandra Eades
- Sydney School of Public Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales 2006 Australia
| | - Brian Oldenburg
- Global Health and Society Unit, Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, L3/89 Commercial Rd, Prahan, Victoria, 3181 Australia
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Baek ES, Park HJ. Effects of a Case Management Program on Self-efficacy, Depression and Anxiety in Pregnant Women with Gestational Diabetes Mellitus. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2013; 19:88-98. [PMID: 37684755 DOI: 10.4069/kjwhn.2013.19.2.88] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023] Open
Abstract
PURPOSE To examine the effects of a case management program on self-efficacy, depression and anxiety in pregnant women with gestational diabetes mellitus. METHODS Thirty-seven patients who enrolled in a diabetes outpatient clinic were randomly assigned to either an experimental group (n=19) or a control group (n=18). The experimental group received a 2-week intervention composed of a series of one face-to-face interactive interview and five telephone interviews based on the National standards for diabetes self-management education and Bandura's self-efficacy resources of performance accomplishment, vicarious experience, verbal persuasion, and emotional arousal. The effects of the intervention were assessed by completion of a 9-item self-efficacy questionnaire, a 20-item depression questionnaire and a 20-item anxiety questionnaire prior to, and after the intervention. The statistical significances were examined using t-test. RESULTS The change in self-efficacy was significantly greater in the experimental group than in the control group. Depression and anxiety changes in the experimental group were significantly greater compared to those in the control group. CONCLUSION The results of study suggest that a case management program improves self-efficacy, and decreases depression and anxiety in pregnant women with gestational diabetes mellitus.
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Affiliation(s)
| | - Hye Ja Park
- Bundang CHA General Hospital, Seongnam, Korea
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Chamberlain C, McNamara B, Williams ED, Yore D, Oldenburg B, Oats J, Eades S. Diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States. Diabetes Metab Res Rev 2013; 29:241-56. [PMID: 23315909 PMCID: PMC3698691 DOI: 10.1002/dmrr.2389] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2012] [Revised: 12/13/2012] [Accepted: 12/20/2012] [Indexed: 12/16/2022]
Abstract
Recently proposed international guidelines for screening for gestational diabetes mellitus (GDM) recommend additional screening in early pregnancy for sub-populations at a high risk of type 2 diabetes mellitus (T2DM), such as indigenous women. However, there are criteria that should be met to ensure the benefits outweigh the risks of population-based screening. This review examines the published evidence for early screening for indigenous women as related to these criteria. Any publications were included that referred to diabetes in pregnancy among indigenous women in Australia, Canada, New Zealand and the United States (n = 145). The risk of bias was appraised. There is sufficient evidence describing the epidemiology of diabetes in pregnancy, demonstrating that it imposes a significant disease burden on indigenous women and their infants at birth and across the lifecourse (n = 120 studies). Women with pre-existing T2DM have a higher risk than women who develop GDM during pregnancy. However, there was insufficient evidence to address the remaining five criteria, including the following: understanding current screening practice and rates (n = 7); acceptability of GDM screening (n = 0); efficacy and cost of screening for GDM (n = 3); availability of effective treatment after diagnosis (n = 6); and effective systems for follow-up after pregnancy (n = 5). Given the impact of diabetes in pregnancy, particularly undiagnosed T2DM, GDM screening in early pregnancy offers potential benefits for indigenous women. However, researchers, policy makers and clinicians must work together with communities to develop effective strategies for implementation and minimizing the potential risks. Evidence of effective strategies for primary prevention, GDM treatment and follow-up after pregnancy are urgently needed.
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Affiliation(s)
- Catherine Chamberlain
- International Public Health Unit, Department of Epidemiology and Preventive Medicine, School of Medicine, Nursing and Health Sciences, Monash University, Prahan, Victoria, Australia.
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Hezelgrave NL, Rajasingham D, Shennan AH, Torloni MR. Mild gestational diabetes: towards a redefined threshold? Expert Rev Endocrinol Metab 2012; 7:669-676. [PMID: 30754119 DOI: 10.1586/eem.12.59] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Gestational diabetes mellitus (GDM), the most common medical complication of pregnancy, is defined as carbohydrate intolerance resulting in hyperglycemia of variable severity with onset or first recognition during pregnancy. In reality, gestational diabetes mellitus is a spectrum of maternal hyperglycemia caused or exacerbated by pregnancy, in which blood glucose levels lie along a continuum, associated with a wide spectrum of metabolic abnormalities and conferring varying degrees of pregnancy-related risk. In recent years, the WHO diagnostic thresholds in current use have been called into question, as increasing evidence mounts that 'mild gestational diabetes' confers increased maternal and fetal risk, despite glucose levels falling below current thresholds. This review summarizes the existing evidence, unanswered questions and health service implications related to women with so-called 'mild' gestational diabetes.
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Affiliation(s)
| | | | | | - M Regina Torloni
- b Obstetric Department, São Paulo Federal University, São Paulo, Brazil
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Harris JM, Franck L, Michie S. Assessing the psychological effects of prenatal screening tests for maternal and foetal conditions: a systematic review. J Reprod Infant Psychol 2012. [DOI: 10.1080/02646838.2012.710834] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- James Matthew Harris
- a Department of Clinical, Educational and Health Psychology , University College London , London , UK
| | - Linda Franck
- b University of California–San Francisco, Family Health Care Nursing , San Francisco , CA , USA
| | - Susan Michie
- a Department of Clinical, Educational and Health Psychology , University College London , London , UK
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Hirst JE, Tran TS, Do MAT, Rowena F, Morris JM, Jeffery HE. Women with gestational diabetes in Vietnam: a qualitative study to determine attitudes and health behaviours. BMC Pregnancy Childbirth 2012; 12:81. [PMID: 22873351 PMCID: PMC3449178 DOI: 10.1186/1471-2393-12-81] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 07/31/2012] [Indexed: 11/10/2022] Open
Abstract
Background Diabetes is increasing in prevalence globally, notably amongst populations from low- and middle- income countries. Gestational Diabetes Mellitus(GDM), a precursor for type 2 diabetes, is increasing in line with this trend. Few studies have considered the personal and social effects of GDM on women living in low and middle-income countries. The aim of this study was determine attitudes and health behaviours of pregnant women with GDM in Vietnam. Methods This was a qualitative study using focus group methodology conducted in Ho Chi Minh City. Pregnant women, aged over 18 years, with GDM were eligible to participate. Women were purposely sampled to obtain a range of gestational ages and severity of disease. They were invited to attend a 1-hour focus group. Questions were semi structured around six themes. Focus groups were recorded, transcribed, translated and cross-referenced. Non-verbal and group interactions were recorded. Thematic analysis was performed using a theoretical framework approach. Results From December 2010 to February 2011, four focus groups were conducted involving 34 women. Median age was 31.5 years (range 23 to 44), median BMI 21.8 kg/m2. Women felt confusion, anxiety and guilt about GDM. Many perceived their baby to be at increased risk of death. Advice to reduce dietary starch was confusing. Women reported being ‘hungry’ or ‘starving’ most of the time, unaware of appropriate food substitutions. They were concerned about transmission of GDM through breast milk. Several women planned not to breastfeed. All felt they needed more information. Current sources of information included friends, magazines, a health phone line or the Internet. Women felt small group sessions and information leaflets could benefit them. Conclusions This study highlights the need for culturally appropriate clinical education and health promotion activities for women with GDM in Vietnam.
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Affiliation(s)
- Jane E Hirst
- Department of Obstetrics & Gynaecology, Sydney Medical School- Northern, University of Sydney, Royal North Shore Hospital, Sydney, NSW, Australia.
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Wickramasinghe N, Troshani I, Hill SR, Hague W, Goldberg S. A Transaction Cost Assessment of a Pervasive Technology Solution for Gestational Diabetes. INTERNATIONAL JOURNAL OF HEALTHCARE INFORMATION SYSTEMS AND INFORMATICS 2011. [DOI: 10.4018/jhisi.2011100104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Diabetes is one of the leading chronic diseases affecting Australians and its prevalence continues to rise. It is becoming a serious challenge for both the quality of healthcare and expenditure in the Australian healthcare system. The goal of this study is to investigate the development and application of a pervasive wireless technology solution to facilitate the effective management of diabetes in the context of women with gestational diabetes. Gestational diabetes is a form of diabetes that affects up to 8% of pregnant women. A transactions cost assessment of this solution is also provided. Integral to the success of this solution is the pervasive technology solution which serves to support and facilitate superior diabetes self-management.
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BANDYOPADHYAY M, SMALL R, DAVEY MA, OATS JJN, FORSTER DA, AYLWARD A. Lived experience of gestational diabetes mellitus among immigrant South Asian women in Australia. Aust N Z J Obstet Gynaecol 2011; 51:360-4. [DOI: 10.1111/j.1479-828x.2011.01322.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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THOMPSON JF, ROBERTS CL, ELLWOOD DA. Emotional and physical health outcomes after significant primary post-partum haemorrhage (PPH): A multicentre cohort study. Aust N Z J Obstet Gynaecol 2011; 51:365-71. [DOI: 10.1111/j.1479-828x.2011.01317.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Dalfrà MG, Nicolucci A, Bisson T, Bonsembiante B, Lapolla A. Quality of life in pregnancy and post-partum: a study in diabetic patients. Qual Life Res 2011; 21:291-8. [PMID: 21633879 DOI: 10.1007/s11136-011-9940-5] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2011] [Indexed: 12/20/2022]
Abstract
PURPOSE We evaluated quality of life in pregnant women with diabetes followed up at Italian diabetes clinics. METHODS A total of 245 pregnant women (30 type 1 diabetes mellitus (T1DM), 176 gestational diabetes (GDM) and 39 controls) were asked to fill in a questionnaire including the SF-36 Health Survey and the Center for Epidemiological Studies-Depression (CES-D) Scale in third trimester of pregnancy and after delivery. GDM and T1DM also completed two diabetes-specific questionnaires (Diabetes-related stress and Diabetes health distress). Quality of life scores were compared between the groups with the Mann-Whitney U-test, mean changes in scores (after delivery to 3rd trimester) were compared between groups by ANCOVA. RESULTS Regarding the SF-36 scores in the third trimester of pregnancy, T1DM and GDM women had a better Standardised Physical Component score than controls (P < 0.0001, P = 0.009, respectively). GDM and T1DM pregnant women scored significantly lower for general health perception than controls (P = 0.009 and P = 0.001, respectively). T1DM patients had lower Standardised Mental Component scores than controls (P = 0.03). Compared with the third trimester of pregnancy, the severity of depressive symptoms increased significantly after delivery in both diabetic groups, but not in controls (P < 0.0001). Scores improved in all SF-36 areas in healthy and GDM women, while they all became worse in the T1DM group. CONCLUSIONS Pregnancy is associated with a perception of poor general health in women with both T1DM and GDM. After delivery, significantly worse depressive symptoms were documented in both groups, while a generally worse physical and psychological well-being was only identified in women with T1DM. These findings have important implications for pregnancy follow-up.
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Affiliation(s)
- M G Dalfrà
- DPT Scienze Mediche e Chirurgiche, Università di Padova, Via Giustiniani 2, 35128, Padova, Italy
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Hiéronimus S, Le Meaux JP. Relevance of gestational diabetes mellitus screening and comparison of selective with universal strategies. DIABETES & METABOLISM 2011; 36:575-86. [PMID: 21163422 DOI: 10.1016/j.diabet.2010.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To assess the relevance of gestational diabetes mellitus (GDM) screening policies and to compare selective with universal screening. METHODS Systematic review of all French and English language publications in the Medline and Cochrane Databases, published since 1990. RESULTS Maternal hyperglycaemia is associated with increased maternal and neonatal complications. The 75g OGTT (Oral Glucose Tolerance Test) is a valid and reliable test for GDM diagnosis. Treatment of GDM reduces perinatal complications. Selective screening helps limit false positive rates and concentrate medical resources. Nevertheless, screening could be more difficult and lead to missing up to 45% of GDM cases. Universal screening offers higher sensitivity but leads to more therapeutic interventions whose benefit and cost/effectiveness ratio need to be estimated in low risk women. CONCLUSION The benefits of GDM screening and treatment have only been proven for women with GDM risk factors. Their relevance in women without risk factor remains controversial.
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Affiliation(s)
- S Hiéronimus
- Hôpital l’Archet Centre hospitalier universitaire de Nice, Service d’endocrinologie-maladies métaboliques-médecine de la reproduction, 06202 Nice, France
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Beucher G, Viaris de Lesegno B, Dreyfus M. Maternal outcome of gestational diabetes mellitus. DIABETES & METABOLISM 2011; 36:522-37. [PMID: 21163418 DOI: 10.1016/j.diabet.2010.11.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate maternal outcome of treated or untreated gestational diabetes mellitus (GDM). METHODS French and English publications were searched using PubMed and the Cochrane library. RESULTS The diagnosis of GDM includes a high risk population for preeclampsia and Caesarean sections (EL3). The risks are positively correlated with the level of hyperglycaemia in a linear way (EL2). Intensive treatment of mild GDM compared with routine care reduces the risk of pregnancy-induced hypertension (preeclampsia, gestational hypertension). Moreover, it does not increase the risk of operative vaginal delivery, Caesarean section and postpartum haemorrhage (EL1). Being overweight, obesity and maternal hyperglycaemia are independent risk factors for preeclampsia (EL2). Their association with GDM increases the risk of preeclampsia and Caesarean section compared to diabetic women with a normal body mass index (EL3). The association of several risk factors (such as advanced maternal age, pre-existing chronic hypertension, pre-existing nephropathy, obesity, suboptimal glycaemic control) increases the risk of preeclampsia. In that case, the classic follow-up (blood pressure measurement, proteinuria) should be more frequent than monthly (professional consensus). The risk of Caesarean section is increased by macrosomia, whether suspected prenatally or not, but this increased risk remains whatever the birth weight (EL3). Diagnosis and treatment of GDM do not reduce the risk of severe perineal lesions, operative vaginal delivery and postpartum haemorrhage (EL2). Some psychological symptoms, such as anxiety and alteration of self-perception, can occur upon diagnosis of GDM (EL3). The treatment of GDM appears to reduce the risk of postpartum depression symptoms (EL2). CONCLUSION Most of the information published on GDM covers the risks of preeclampsia and Caesarean section; intensive care of GDM reduces these risks. Pregnancy care should be adjusted to the risk factors.
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Affiliation(s)
- G Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, Avenue Côte de Nacre, 14033 Caen cedex 9, France.
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Beucher G, Viaris de Lesegno B, Dreyfus M. Complications maternelles du diabète gestationnel. ACTA ACUST UNITED AC 2010; 39:S171-88. [DOI: 10.1016/s0368-2315(10)70045-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Hiéronimus S, Le Meaux JP. Intérêt du dépistage du diabète gestationnel et comparaison des stratégies ciblée et systématique. ACTA ACUST UNITED AC 2010; 39:S200-13. [DOI: 10.1016/s0368-2315(10)70047-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lawrence JM. Women with diabetes in pregnancy: different perceptions and expectations. Best Pract Res Clin Obstet Gynaecol 2010; 25:15-24. [PMID: 21115403 DOI: 10.1016/j.bpobgyn.2010.10.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Accepted: 10/06/2010] [Indexed: 12/16/2022]
Abstract
Given the increasing incidence of type 1 diabetes, the recent emergence of type 2 diabetes as a condition that can begin during childhood, and the increasing prevalence of gestational diabetes mellitus, the number of women who have some form of diabetes during their pregnancies is increasing. The perceptions and expectations of women with diabetes during pregnancy may affect their psychological response to pregnancy as well as their behaviour during and after pregnancy. This article provides an overview of the epidemiology of diabetes in pregnancy, including diabetes diagnosed before pregnancy and gestational diabetes mellitus. Then, the limited number of studies about women's perceptions of diabetes and pregnancy, based on interviews conducted during or shortly after pregnancy, are reviewed. We present information about how health professionals may manage these perceptions and expectations, based on the findings of these studies, as well as areas for future research.
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Affiliation(s)
- Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, 91101, USA.
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Ouzounian JG, Rosenheck R, Lee RH, Yedigarova L, Walden CL, Korst LM. One-hour post-glucola results and pre-pregnancy body mass index are associated with the need for insulin therapy in women with gestational diabetes. J Matern Fetal Neonatal Med 2010; 24:718-22. [PMID: 20937005 DOI: 10.3109/14767058.2010.521869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the relationship of 1-h post-glucola (PG) screening results and the need for insulin therapy in women with gestational diabetes (GDM). METHODS The study group was comprised of women with GDM treated at a single institution during calendar years 2000-2004. Women with singleton, term (≥ 37 weeks gestation), liveborn fetuses were included. The association of 1-h PG results and other perinatal risk factors to the need for subsequent insulin therapy was analyzed using multivariable logistic regression models. RESULTS Of the 1451 women were included in the analysis, 18.1% required insulin treatment. The mean 1-h PG result was 170.0 ± 26.1 mg/dl (range 140-414 mg/dl). We determined that a 1-h PG ≥ 190 mg/dl (p < 0.0001), an obese body mass index (BMI) (p < 0.0001), an overweight BMI (p = 0.0019), prior GDM (p = 0.0019), and prior macrosomia (p = 0.0210) were each highly associated with the need for subsequent insulin therapy during the pregnancy. CONCLUSIONS A 1-h PG ≥ 190 mg/dl was strongly associated with the need for insulin therapy in women with GDM. These data may be helpful in counseling and managing women with GDM.
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Affiliation(s)
- Joseph G Ouzounian
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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